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Analysis of Three Outbreaks Due to Klebsiella Species in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Melek Ayan ,
Cigdem Kuzucu ,
Riza Durmaz ,
Elif Aktas  and
Zeynep Cizmeci
Melek Ayan
Affiliation:
Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
Cigdem Kuzucu
Affiliation:
Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
Riza Durmaz*
Affiliation:
Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
Elif Aktas
Affiliation:
Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
Zeynep Cizmeci
Affiliation:
Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
*
Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Inonu University, 44069 - Malatya, Turkey
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Abstract

Objective:

To investigate the clinical, microbiological, and epidemiologic features of three outbreaks caused by Klebsiella during 3 years.

Setting:

Neonatal intensive care unit of a university hospital.

Patients:

Thirty affected neonates.

Methods:

Data were collected through chart reviews and conversations with physicians. Screening samples were obtained from the staff, the neonates, and the environment. Antibiogram typing and arbitrarily primed polymerase chain reaction-based fingerprinting were used to type the strains.

Results:

The first outbreak had 13 K. pneumoniae strains isolated. The second outbreak had 10 K. oxytoca strains isolated. The third outbreak had 20 K. pneumoniae strains isolated. More than half of the patients had low birth weights, were premature, and underwent mechanical ventilation and intravenous catheterization. Approximately three-fourths of the patients died. The isolates tested were completely susceptible to meropenem, cefoxitin, and ciprofloxacin and were resistant to cephalothin. More than half of these strains were resistant to many beta-lactam antibiotics, amikacin, and trimethoprim/sul-famethoxazole. Typing procedures yielded 3 antibiotypes and 3 genotypes among the isolates of the first outbreak, 3 antibiotypes with 1 subtype and 2 genotypes with 1 subtype in the second outbreak, and 2 antibiotypes and 2 genotypes in the third outbreak.

Conclusions:

Klebsiella outbreaks mainly affected premature neonates with intravenous catheters, mechanical ventilation, or both. The high mortality rate (76.7%) was notable. Resistance to multiple antibiotics, but mainly to broad-spectrum beta-lactam antibiotics, was observed, particularly in K. pneumoniae isolates. Molecular typing indicated that the three outbreaks were not related to one other (Infect Control Hosp Epidemiol 2003;24:495-500).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 7 , July 2003 , pp. 495 - 500
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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